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WE OF Alcoholics Anonymous believe that the 
reader will be interested in the medical esti- 
mate of the plan of recovery described in this book. 
Convincing testimony must surely come from medical 
men who have had experience with the sufferings of 
our members and have witnessed our return to health. 
A well-known doctor, chief physician at a nationally 
prominent hospital specializing in alcoholic and drug 
addiction, gave Alcoholics Anonymous this letter: 

     To Whom It May Concern: 
       I have specialized in the treatment of alcoholism 
     for many years. 
       In late 1934 I attended a patient who, though he had 
     been a competent businessman of good earning ca- 
     pacity, was an alcoholic of a type I had come to regard 
     as hopeless. 
       In the course of his third treatment he acquired cer- 
     tain ideas concerning a possible means of recovery. As 
     part of his rehabilitation he commenced to present his 
     conceptions to other alcoholics, impressing upon them 
     that they must do likewise with still others. This has 
     become the basis of a rapidly growing fellowship of 
     these men and their families. This man and over one 
     hundred others appear to have recovered. 
       I personally know scores of cases who were of the 
     type with whom other methods had failed completely. 
       These facts appear to be of extreme medical impor- 
     tance; because of the extraordinary possibilities of rapid


xxiv                     THE DOCTOR'S OPINION 

     growth inherent in this group they may mark a new 
     epoch in the annals of alcoholism. These men may 
     well have a remedy for thousands of such situations. 
       You may rely absolutely on anything they say about 
     themselves.       Very truly yours, 

     William D. Silkworth, M.D.
The physician who, at our request, gave us this let- 
ter, has been kind enough to enlarge upon his views in 
another statement which follows. In this statement he 
confirms what we who have suffered alcoholic torture 
must believe—that the body of the alcoholic is quite as 
abnormal as his mind. It did not satisfy us to be told 
that we could not control our drinking just because we 
were maladjusted to life, that we were in full flight 
from reality, or were outright mental defectives. These 
things were true to some extent, in fact, to a consider- 
able extent with some of us. But we are sure that our 
bodies were sickened as well. In our belief, any pic- 
ture of the alcoholic which leaves out this physical 
factor is incomplete. 
The doctor's theory that we have an allergy to al- 
cohol interests us. As laymen, our opinion as to its 
soundness may, of course, mean little. But as ex- 
problem drinkers, we can say that his explanation 
makes good sense. It explains many things for which 
we cannot otherwise account. 
Though we work out our solution on the spiritual as 
well as an altruistic plane, we favor hospitalization for 
the alcoholic who is very jittery or befogged. More 
often than not, it is imperative that a man's brain be 
cleared before he is approached, as he has then a bet- 

THE DOCTOR'S OPINION                         xxv 
ter chance of understanding and accepting what we 
have to offer. 
    The doctor writes: 

The subject presented in this book seems to me to be of 
paramount importance to those afflicted with alcoholic 
I say this after many years' experience as Medical 
Director of one of the oldest hospitals in the country treat- 
ing alcoholic and drug addiction. 
There was, therefore, a sense of real satisfaction when I 
was asked to contribute a few words on a subject which is 
covered in such mastery detail in these pages. 
We doctors have realized for a long time that some form 
of moral psychology was of urgent importance to alcoholics, 
but its application presented difficulties beyond our concep- 
tion. What with our ultra-modern standards, our scientific 
approach to everything, we are perhaps not well equipped 
to apply the powers of good that lie outside our synthetic 
Many years ago one of the leading contributors to this 
book came under our care in this hospital and while here 
he acquired some ideas which he put into practical applica- 
tion at once. 
Later, he requested the privilege of being allowed to tell 
his story to other patients here and with some misgiving, 
we consented. The cases we have followed through have 
been most interesting; in fact, many of them are amazing. 
The unselfishness of these men as we have come to know 
them, the entire absence of profit motive, and their com- 
munity spirit, is indeed inspiring to one who has labored 
long and wearily in this alcoholic field. They believe in 
themselves, and still more in the Power which pulls chronic 
alcoholics back from the gate of death. 
Of course an alcoholic ought to be freed from his physical 

xxvi                    THE DOCTOR'S OPINION 
craving for liquor, and this often requires a definite hospital 
procedure, before psychological measures can be of maxi- 
mum benefit. 
We believe, and so suggested a few years ago, that the 
action of alcohol on these chronic alcoholics is a manifesta- 
tion of an allergy; that the phenomenon of craving is limited 
to this class and never occurs in the average temperate 
drinker. These allergic types can never safely use alcohol 
in any form at all; and once having formed the habit and 
found they cannot break it, once having lost their self- 
confidence, their reliance upon things human, their prob- 
lems pile up on them and become astonishingly difficult 
to solve. 
Frothy emotional appeal seldom suffices. The message 
which can interest and hold these alcoholic people must 
have depth and weight. In nearly all cases, their ideals 
must be grounded in a power greater than themselves, if 
they are to re-create their lives. 
If any feel that as psychiatrists directing a hospital for 
alcoholics we appear somewhat sentimental, let them stand 
with us a while on the firing line, see the tragedies, the 
despairing wives, the little children; let the solving of these 
problems become a part of their daily work, and even of 
their sleeping moments, and the most cynical will not 
wonder that we have accepted and encouraged this move- 
ment. We feel, after many years of experience, that we 
have found nothing which has contributed more to the 
rehabilitation of these men than the altruistic movement 
now growing up among them. 
Men and women drink essentially because they like the 
effect produced by alcohol. The sensation is so elusive that, 
while they admit it is injurious, they cannot after a time 
differentiate the truth from the false. To them, their alco- 
holic life seems the only normal one. They are restless, 
irritable and discontented, unless they can again experience 

THE DOCTOR'S OPINION                    xxvii 
the sense of ease and comfort which comes at once by tak- 
ing a few drinks—drinks which they see others taking with 
impunity. After they have succumbed to the desire again, 
as so many do, and the phenomenon of craving develops, 
they pass through the well-known stages of a spree, emerg- 
ing remorseful, with a firm resolution not to drink again. 
This is repeated over and over, and unless this person can 
experience an entire psychic change there is very little hope 
of his recovery. 
On the other hand—and strange as this may seem to those 
who do not understand—once a psychic change has occurred, 
the very same person who seemed doomed, who had so 
many problems he despaired of ever solving them, suddenly 
finds himself easily able to control his desire for alcohol, 
the only effort necessary being that required to follow a 
few simple rules. 
Men have cried out to me in sincere and despairing ap- 
peal: "Doctor, I cannot go on like this! I have everything 
to live for! I must stop, but I cannot! You must help me!" 
Faced with this problem, if a doctor is honest with him- 
self, he must sometimes feel his own inadequacy. Although 
he gives all that is in him, it often is not enough. One feels 
that something more than human power is needed to pro- 
duce the essential psychic change. Though the aggregate 
of recoveries resulting from psychiatric effort is consider- 
able, we physicians must admit we have made little 
impression upon the problem as a whole. Many types do 
not respond to the ordinary psychological approach. 
I do not hold with those who believe that alcoholism is 
entirely a problem of mental control. I have had many 
men who had, for example, worked a period of months on 
some problem or business deal which was to be settled on 
a certain date, favorably to them. They took a drink a day 
or so prior to the date, and then the phenomenon of craving 
at once became paramount to all other interests so that the 

xxviii                     THE DOCTOR'S OPINION 
important appointment was not met. These men were not 
drinking to escape; they were drinking to overcome a crav- 
ing beyond their mental control. 
There are many situations which arise out of the phenom- 
enon of craving which causes men to make the supreme 
sacrifice rather than continue to fight. 
The classification of alcoholics seems most difficult, and 
in much detail is outside the scope of this book. There are, 
of course, the psychopaths who are emotionally unstable. 
We are all familiar with this type. They are always "going 
on the wagon for keeps." They are over-remorseful and 
make many resolutions, but never a decision. 
There is the type of man who is unwilling to admit that 
he cannot take a drink. He plans various ways of drinking. 
He changes his brand or his environment. There is the type 
who always believes that after being entirely free from 
alcohol for a period of time he can take a drink without 
danger. There is the manic-depressive type, who is, per- 
haps, the least understood by his friends, and about whom 
a whole chapter could be written. 
Then there are types entirely normal in every respect 
except in the effect alcohol has upon them. They are often 
able, intelligent, friendly people. 
All these, and many others, have one symptom in com- 
mon; they cannot start drinking without developing the 
phenomenon of craving. This phenomenon, as we have 
suggested, may be the manifestation of an allergy which 
differentiates these people, and sets them apart as a distinct 
entity. It has never been, by any treatment with which we 
are familiar, permanently eradicated. The only relief we 
have to suggest is entire abstinence. 
This immediately precipitates us into a seething caldron 
of debate. Much has been written pro and con, but among 
physicians, the general opinion seems to be that most 
chronic alcoholics are doomed. 

THE DOCTOR'S OPINION                     xxix 
What is the solution? Perhaps I can best answer this by 
relating one of my experiences. 
About one year prior to this experience a man was 
brought in to be treated for chronic alcoholism. He had 
but partially recovered from a gastric hemorrhage and 
seemed to be a case of pathological mental deterioration. 
He had lost everything worthwhile in life and was only 
living, one might say, to drink. He frankly admitted and 
believed that for him there was no hope. Following the 
elimination of alcohol, there was found to be no permanent 
brain injury. He accepted the plan outlined in this book. 
One year later he called to see me, and I experienced a 
very strange sensation. I knew the man by name, and 
partly recognized his features, but there all resemblance 
ended. From a trembling, despairing, nervous wreck, had 
emerged a man brimming over with self-reliance and con- 
tentment. I talked with him for some time, but was not 
able to bring myself to feel that I had known him before. 
To me he was a stranger, and so he left me. A long time 
has passed with no return to alcohol. 
When I need a mental uplift, I often think of another 
case brought in by a physician prominent in New York. 
The patient had made his own diagnosis, and deciding his 
situation hopeless, had hidden in a deserted barn deter- 
mined to die. He was rescued by a searching party, and, 
in desperate condition, brought to me. Following his 
physical rehabilitation, he had a talk with me in which he 
frankly stated he thought the treatment a waste of effort, 
unless I could assure him, which no one ever had, that in 
the future he would have the "will power" to resist the 
impulse to drink. 
His alcoholic problem was so complex, and his depres- 
sion so great, that we felt his only hope would be through 
what we then called "moral psychology," and we doubted 
if even that would have any effect. 

xxx                      THE DOCTOR'S OPINION 
However, he did become "sold" on the ideas contained 
in this book. He has not had a drink for a great many years. 
I see him now and then and he is as fine a specimen of 
manhood as one could wish to meet. 
I earnestly advise every alcoholic to read this book 
through, and though perhaps he came to scoff, he may re- 
main to pray. 
William D. Silkworth, M.D. 


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